资源描述:
《电视纵隔镜在胸部疾病中的应用体会》由会员上传分享,免费在线阅读,更多相关内容在应用文档-天天文库。
1、电视纵隔镜在胸部疾病中的应用体会【摘要】目的:探讨电视纵隔镜检查术(video-mediastinoscopy,VM)在肺癌(无肺癌根治术指征者)、纵隔肿物和恶性胸腔积液诊断中的应用价值。方法:采用全麻并气管插管,71例经胸骨上窝纵隔镜活检术,40例经胸骨旁纵隔镜检查术,49例经肋间纵隔镜手术。结果:160例经VM术后确诊肺鳞癌41例、肺腺癌39例、肺小细胞癌9例、肺大细胞癌1例、腺鳞癌2例、淋巴结炎症9例、淋巴结核12例、结核性胸膜炎4例、胸腺癌4例、非霍奇金淋巴瘤4例、霍奇金淋巴瘤3例、心包囊肿1例、胸膜间皮瘤5例、纵隔神经母细胞瘤3例、纵
2、隔纤维肉瘤1例、胸腺瘤5例、后纵隔神经鞘瘤3例、结节病13例、胸腺增生1例;术中发生出血2例,结核切口延迟愈合和切口感染各1例。结论:VM不但是部分肺癌、纵隔疾病的重要检查方法,也是诊治恶性胸腔积液的首选方法。【关键词】电视纵隔镜;肺癌;纵隔肿物;胸腔积液 AbstractObjective:Tostudytheapplicationofvideo-mediastinoscopyinlungcancerentofmediastinaltumorsormalignantpleuraleffusion.Methods:Video-mediasti
3、noscopyedin160casesundergeneralanesthesiaandsinglelumenendotrachealintubation,including71casesofcervicalmediastinoscopy,40casesofparasternalmediastinoscopy,and49casesofintercostalmediastinoscopy.Results:Thediagnosisediastinoscopyin160cases,including39casesofadenocarcinoma,41
4、casesofsquamouscellcarcinoma,9casesofsmallcellcarcinoma,1caseoflargecelllungcarcinoma,2casesofadenosquamouscarcinoma,12casesofnodetuberculosis,9casesoflymphnodeinflammation,4casesoftuberculouspleuritis,4casesofcarcinomaofthethymus,4casesofnon-Hodgkin'slymphoma,3casesofHodgki
5、n'slymphoma,1caseofpericardialcyst,5casesofpleuralmesothelioma,3casesofneuroblastoma,1caseofmediastinalfibrosara,5casesofthymoma,3casesofpostmediastinumneurilemmoma,13casesofsarcoidosis,1caseofhyperplasiaofthymus.plicationsincluded2casesofhemorrhage,1caseofsuperficialincisio
6、ninfectionand1tuberculosisincisiondelayedunion.Conclusions:Video-mediastinoscopyisnotonlyanimportantassivemediastinaldiseasesbutalsotreatmentmalignantpleuraleffusion. Keyediastinoscopy;Lungcancer;Mediastinalmass;Pleuraleffusion 纵隔镜起初只用于颈部和上纵隔的活检和探查,胸腔镜的摄像系统和纵隔镜的完美结合,即电视纵隔镜
7、(video-mediastinoscopy,VM),已不仅用于活检诊断,还用于胸部疾病的治疗。2007年10月至2009年12月,我们为160例拟诊肺癌、纵隔肿物和恶性胸腔积液患者进行电视纵隔镜(video-mediastinoscopy,VM)活检手术,现报告如下。 1对象与方法 1.1对象本组160例,男119例,女41例;年龄33~79岁,平均54.7岁;病程从3d至2.5年不等;全部经过DR胸片及胸部CT检查,部分病人经过PET-CT检查。本组除1例外,术前均未能明确病理诊断,但高度怀疑肺癌90例、结节病或淋巴结核26例、恶性或结
8、核性胸水9例,其余患者临床诊断为纵隔肿瘤。 1.2方法全部全麻并单腔气管插管。 1.2.171例经胸骨上窝前纵隔肿物纵隔镜活检术(cervical